The Swedish grommet register - Hearing results and adherence to guidelines

The insertion of grommets is one of the most commonly performed surgical procedures in children. The underlying reason might be otitis media with effusion (OME) with concomitant hearing loss, recurrent acute otitis media (rAOM) or a combination of the two. Sweden has a national quality register for children receiving grommets with the purpose of evaluating how treatment guidelines are followed, and if surgery confers good quality health care. The purpose of this study was to investigate the circumstances during which Swedish children receive grommets and to examine how doctors follow the guidelines for grommet surgery.

Quality register data was extracted from 2010 to 2016, and information on reasons for surgery, audiometry, number of AOM episodes, type of grommet etc was analysed.

The dominating reason for surgery was OME (71%). A large proportion (27%) of children with OME had not undergone a preoperative audiometry, despite national guidelines stating that it is hearing impairment that calls for surgery. Furthermore, among those who had done audiometry, 47% did not have a hearing impairment as measured by pure tone average. Nevertheless, a significant hearing improvement (11 dB, p < 0.001) was seen on post-operative follow-ups in those children who underwent audiometry. Forty-four percent of children operated due to rAOM had had fewer episodes of AOM than recommended as an indication for surgery, though this figure should be interpreted with caution as GP diagnosed episodes are not entered in the register.

Even though grommet insertions are quick and confer a low per-operative risk, it seems many children undergo surgery without a clear indication. This puts them at an unnecessary risk of per-operative as well as long-term complications. Since the procedure is so common, it also means large sums of money are spent on operations that might not be necessary.